University of New Mexico, Albuquerque, New Mexico.
San Francisco VA Medical Center, San Francisco, California.
J Stud Alcohol Drugs. 2018 Mar;79(2):217-222. doi: 10.15288/jsad.2018.79.217.
There is evidence of a causal chain in motivational interviewing (MI) involving counselor MI-consistent skills, client change language, and outcomes. MI was a key component of the combined behavioral intervention in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. Participants in COMBINE were treatment-seeking and medication-seeking, and were required to maintain a period of abstinence before enrollment. Counselors were closely monitored and were temporarily removed from the study for remediation and supervision if their performance fell below threshold. The purpose of this study was to evaluate the MI causal chain among initial-session combined behavioral intervention audio recordings in this unique sample of highly motivated clients and highly monitored counselors.
Session 1 audio recordings (N = 254, 73.5% men) were evaluated using the Motivational Interviewing Skill Code Version 2.0 with good interrater reliability. Counselor speech was measured using a summary measure of MI-consistent behavior. Client change language was assessed, using change talk and sustain talk. The outcome measure of drinks per week was computed using the COMBINE data set.
Higher sustain talk was significantly associated with increased drinking during treatment, whereas higher change talk was significantly associated with decreased drinking at the 1-year follow-up. In addition, there were significant indirect effects linking counselor behavior, client speech, and drinking both during treatment and at 1 year.
Results supported the posited causal chain for MI. Despite somewhat lower variability of counselor behavior and use of a coding instrument that did not capture directional counselor behaviors, counselor behavior, client speech, and drinking outcomes were clearly linked in this unique sample.
有证据表明，在动机访谈（MI）中存在一个因果链，其中包括咨询师的 MI 一致技能、客户的改变语言和结果。MI 是联合药理学和行为干预治疗酒精依赖（COMBINE）研究中联合行为干预的关键组成部分。COMBINE 的参与者是寻求治疗和药物治疗的，并且在入组前需要保持一段时间的禁欲。如果咨询师的表现低于阈值，他们将受到密切监测，并暂时被从研究中移除进行补救和监督。本研究的目的是评估在这个高度积极的客户和高度受监督的咨询师的独特样本中，初始会话联合行为干预的音频记录中的 MI 因果链。
使用动机访谈技能编码 2.0 版本对第 1 会话的音频记录（N=254，73.5%为男性）进行评估，其信度较好。使用 MI 一致行为的综合衡量标准来衡量咨询师的演讲。使用改变谈话和维持谈话来评估客户的改变语言。使用 COMBINE 数据集计算每周的饮酒量。
较高的维持谈话与治疗期间饮酒量的增加显著相关，而较高的改变谈话与 1 年随访时的饮酒量减少显著相关。此外，咨询师行为、客户言语和饮酒量在治疗期间和 1 年时都存在显著的间接影响。
结果支持 MI 的假定因果链。尽管咨询师行为的变异性略低，并且使用的编码工具没有捕捉到定向的咨询师行为，但在这个独特的样本中，咨询师行为、客户言语和饮酒结果显然是相关的。
